Mansukhani Neel A, Havelka George E, Helenowski Irene B, Rodriguez Heron E, Hoel Andrew W, Eskandari Mark K
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Surgery. 2017 May;161(5):1414-1422. doi: 10.1016/j.surg.2016.11.006. Epub 2016 Dec 20.
Inferior vena cava repair after planned and unplanned venotomy is performed by either interposition bypass, patch venopasty, or lateral venorrhaphy and primary repair. Primary repair of the inferior vena cava avoids the use of foreign material and allows an all-autologous repair in an expeditious fashion. The purpose of this study was to demonstrate the utility of inferior vena cava repair, determine the degree of inferior vena cava stenosis, and examine clinical outcomes after primary repair.
We conducted a single-center retrospective review of patients who underwent primary inferior vena cava repairs between January 2002 and January 2014 at a tertiary care center. Primary repair followed lateral venorrhaphy for tumor extraction or for repair of an iatrogenic inferior vena cava injury. Patient demographics, cross-sectional vena cava dimensions, and patient outcomes were tabulated.
In total, 47 (30 men and 17 women) patients underwent primary inferior vena cava repair (median age 58 years, range 31-83 years). Twenty-six patients (15 men and 11 women) underwent en bloc radical nephrectomy, inferior vena cava tumor thrombus extraction, and primary lateral venorrhaphy (median age 61 years, range 39-83 years). The majority, 92% of these patients, had renal cell carcinoma on final pathology, with a median follow-up period of 39 months (range 1-108 months). Twenty-one patients (15 men and 6 women) underwent primary repair for iatrogenic inferior vena cava injury (median age 54 years, range 31-82 years). The median follow-up period was 18.5 months (3-110 months). Clinic follow-up with postoperative imaging was obtained in 76.9% of those undergoing tumor thrombus extraction (n = 20) and 76.2% of those undergoing repair of an iatrogenic injury (n = 16). Overall, there was a 13% infrarenal inferior vena cava diameter loss, 17% inferior vena cava diameter loss at the level of the renal veins, and 10% suprarenal inferior vena cava diameter loss when comparing postoperative with preoperative imaging. All patients remained asymptomatic; therefore, inferior vena cava narrowing associated with primary repair was clinically insignificant.
Primary inferior vena cava repair is associated with less than 20% inferior vena cava diameter loss and does not compromise venous outflow from the extremities. Primary inferior vena cava repair is a safe and expeditious technique that provides excellent clinical outcomes and long-term patency.
计划性和非计划性静脉切开术后的下腔静脉修复可通过置入旁路、补片静脉成形术、侧方静脉缝合术或一期修复来完成。下腔静脉一期修复避免使用异体材料，能够以快速的方式实现全自体修复。本研究的目的是证明下腔静脉修复的实用性，确定下腔静脉狭窄程度，并检查一期修复后的临床结果。
我们对2002年1月至2014年1月在一家三级医疗中心接受下腔静脉一期修复的患者进行了单中心回顾性研究。一期修复是在侧方静脉缝合术后进行，用于肿瘤切除或医源性下腔静脉损伤的修复。将患者的人口统计学数据、下腔静脉横断面尺寸和患者结局制成表格。
共有47例患者（30例男性和17例女性）接受了下腔静脉一期修复（中位年龄58岁，范围31 - 83岁）。26例患者（15例男性和11例女性）接受了整块根治性肾切除术、下腔静脉肿瘤血栓切除术和一期侧方静脉缝合术（中位年龄61岁，范围39 - 83岁）。这些患者中，92%最终病理诊断为肾细胞癌，中位随访期为39个月（范围1 - 108个月）。21例患者（15例男性和6例女性）因医源性下腔静脉损伤接受一期修复（中位年龄54岁，范围31 - 82岁）。中位随访期为18.5个月（3 - 110个月）。接受肿瘤血栓切除术的患者中有76.9%（n = 20）以及接受医源性损伤修复的患者中有76.2%（n = 16）进行了术后影像学检查的临床随访。总体而言，与术前影像学检查相比，肾下下腔静脉直径缩小13%，肾静脉水平下腔静脉直径缩小17%，肾上下腔静脉直径缩小10%。所有患者均无症状；因此，与一期修复相关的下腔静脉狭窄在临床上无显著意义。
下腔静脉一期修复与下腔静脉直径缩小不到20%相关，且不影响肢体静脉回流。下腔静脉一期修复是一种安全、快速的技术，能提供良好的临床结果和长期通畅性。
